Ankylosing spondylitis

Ankylosing spondylitis (AS): back pain, with deformations

AS (chronic inflammation of the spine) is today clinically diagnosed with 100.000 people in the UK. It is almost three times more common in men than in women, although it is possible that ratio is more equal since women often suffer from much milder forms of that condition which can usually get past being diagnosed.

AS is mostly a condition found among young people, and it most frequently affects those aging between 15 and 35 years. A condition once considered a component part of rheumatoid arthritis, today we know it is connected to it, but that it is also an individual condition.

 

What is AS?

AS is a type of chronic arthritis which mostly affects the spine (the term "ankylosing" refers to the stiffness, "spondyl" refers to the spine, and "itis" denotes inflammation. The inflammation with AS happens in the joints and the areas in between which tendons and bonds attach themselves to the bones. In serious cases, the spine inflammation may cause the eventual fusion of the spine.

Older people walking slouched, with their eyes pointed at the floor, are usually suffering from late stages of AS. The good news is that modern methods of treatment can almost completely prevent AS from becoming a condition leading to inadequacy or disabilities.

What causes AS?

As in many other types of arthritis, the cause of AS developing is unknown. On the other side, genes have a strong influence - 95% of people suffering from AS in the UK have on the surface of their white blood cells a genetic cell marker, a protein, called HLA-B27. A person carrying the gene HLA-B27 has a 1-2% chance of developing AS, but that risk can rise up to 20% if a parent, brother or sister suffer from the mentioned condition.

How does AS the progress of AS look like?

AS usually develops gradually, almost stealthily. The first symptoms that occur are usually pains in the lower back caused by the inflammation of the pelvical joints, situated in the lower part of the back on both sides of the spine, right above the rear. The pains in the lower back which gradually increase and last for months are often a warning sign pointing to the disease. The back pains may be very severe, disturb one's sleep and force the person to roll on their hip while getting out of bed, as to avoid bending the back.

Upward-moving pain

During its development, AS and the inflammation connected to it might ascend onto the upper part of the back and spread to other joints, especially the neck, hips and shoulders. The spine becomes stiff from the pains and muscle cramps (spasms). The chronic inflammation can in later stages lead to the development of calcaneal spurs between the vertebrae, which leads to a permanent fusion of the spine to a bent and inflexible position.

AS is a systemic disease, so it sometimes affects parts of the body separate from the joints. People suffering from AS may also suffer from fatigue, weight loss, weak appetite and, in approximately 25% of the patients, the inflammation of the iris of the eye called iritis, which causes redness and tearing. People with serious and long-lasting AS may suffer from damage to the heart tissue which demands for the installation of a device to electrostimulate the heart.

How is AS diagnosed?

It can be problematic to diagnose ankylosing spondylitis, especially in its early stages. Usually the medical condition itself can offer the doctor several hints which, joined together, point to AS:

  • The patient is a man aged between 16 and 35 years.
  • The back pains and stiffness have been developing gradually.
  • The symptoms have been present constantly for more than 3 months.
  • The patient's back is stiff upon waking up in the morning.
  • Exercise helps relieve the stiffness and pain.

Sensitivity at the places where the tendons are attached to the bones, sharp pains in the shoulders, rear, back part of the knee or heel, can all be signs of the early stage of ankylosing spondylitis.

Medical examination

The doctor will test the bendability of the patient's spine by, for example, asking him to bend and touch his toes. The doctor may also apply pressure to the patient's pelvical joints to determine how sensitive they are, and he may also conduct a spirometry testing of the lungs which will show whether the patient can inhale completely.

Laboratory tests

The test of the patient's blood to the presence of the HLA-B27 marker can help with confirming the AS diagnosis or with excluding similar conditions such as rheumatoid arthritis or lupus. Otherwise, diagnostic analyses are not very useful with AS.

X-ray

X-ray images may prove a final AS diagnosis, however, the signs of the condition are normally not visible on an X-ray image up until five years after the first appearance of the condition. The first joints to show the signs of ankylosing spondylitis are usually the pelvical joints, which in that case look blurry on a X-ray, due to the fact their surface is worn our because of the inflammation.

What to do?

A person recently diagnosed with AS should have a reasonable degree of hope. The diagnosis was most probably made in one of the early stages. Today's methods of treatment - firstly exercise and the use of NSAR - can almost always prevent the progression of AS to the point of irreversible stiffness of the spine. With them, pains and stiffness are also successfully reduced and they enable most people suffering from ankylosing spondylitis to stay active and lead normal lives.

How is AS treated?

Today's methods of treatment enable most people suffering from AS to lead normal lives. However, to succeed, the approach of co-living with arthritis is very important, with special care given to exercising.

The healing power of physical exercise

The end result of AS can be greatly influenced by physical therapy. The physical therapist will have you learn an everyday exercise program and give you pointers to be aware of your posture. You will also learn how to increase the range of certain joints' movements, especially the shoulders and hips. You should also learn how to stretch out muscles which have been shortened. The national society for ankylosing spondylitis leads and supervises weekly group physical therapy exercises in their local branches.
Although osteopathy and chiropractics are useful for some conditions, they are not recommended for people suffering from AS, because such procedures can be inappropriate.

Medicaments

Regular consumption of NSAR is also important at treating AS, mostly because of their influence on exercise. These anti-inflammatory drugs reduce pain and stiffness in the measure enough to enable patients undergo an active program of physical exercise, which is crucial in preventing the condition from deteriorating.

Source: Translated excerpt from book "Living with Arthritis"

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